新型冠状病毒感染后胰岛移植受者 1 型糖尿病复发。
Type 1 diabetes recurrence after SARS-CoV-2 infection in a subject with pancreas transplantation.
机构信息
Department of Internal Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Diabetes Care Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
出版信息
Endocrinol Diabetes Metab. 2023 Jan;6(1):e364. doi: 10.1002/edm2.364. Epub 2022 Oct 28.
BACKGROUND
During COVID-19 pandemic, several studies have demonstrated a strong link between SARS-CoV-2 infection and diabetes mellitus. Hyperglycaemia is a frequent event during the infection, also in patients without a history of diabetes. Furthermore, several cases of diabetic ketoacidosis during COVID-19 disease have been described. No data are available about the effects of SARS-CoV-2 infection on glycaemic control in pancreas transplant patients.
CASE PRESENTATION
A 45-year-old woman affected by type 1 diabetes mellitus was treated with kidney-pancreas transplantation in 2015, 6 years before COVID-19 infection. After transplantation, insulin therapy was stopped with a good glycaemic control during the following years.After SARS-CoV-2 infection, she developed severe hyperglycaemia requiring insulin therapy again. During the acute phase of the infection, the detection of antibodies against islet cells (ICA) and against glutamic acid decarboxylase (GAD) was found positive.
CONCLUSIONS
The onset of hyperglycaemia after SARS-CoV-2 infection might be the result of a direct virus-induced toxicity or the effect of a virus-mediated activation of autoimmunity.
背景
在 COVID-19 大流行期间，多项研究表明 SARS-CoV-2 感染与糖尿病之间存在密切关联。在感染过程中，高血糖很常见，即使在没有糖尿病病史的患者中也是如此。此外，在 COVID-19 疾病期间已经描述了几例糖尿病酮症酸中毒病例。目前尚无关于 SARS-CoV-2 感染对胰腺移植患者血糖控制影响的相关数据。
病例介绍
一位 45 岁女性，患有 1 型糖尿病，于 2015 年接受了肾胰联合移植，在 COVID-19 感染前 6 年。移植后，她停止了胰岛素治疗，此后多年血糖控制良好。在 SARS-CoV-2 感染后，她出现严重高血糖，再次需要胰岛素治疗。在感染急性期，检测到胰岛细胞抗体（ICA）和谷氨酸脱羧酶（GAD）抗体呈阳性。
结论
SARS-CoV-2 感染后发生高血糖可能是病毒直接诱导毒性的结果，或是病毒介导的自身免疫激活的结果。
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